[Dr. Rodney] Willoughby met with Giese’s shaken parents, Ann and John, to inform them of the test results and to discuss their daughter’s grim prognosis... He gave them three treatment options for their daughter: hospice care, which would allow their daughter a comfortable death at home; the standard critical care regimen, which so far had never been successful in saving an unvaccinated victim of rabies; or the experimental plan that Willoughby and his colleagues had laid out. The Gieses chose the third option without hesitation. They pointed out to Willoughby that even if their daughter didn’t survive her infection, the knowledge gained might help some future child with rabies....

In the tense days that followed, the girl lay motionless in a hospital room, animated only by monitors and by the rhythmic whoosh of the mechanical ventilator.... After Jeanna Giese had spent seven days in a coma, samples were taken of her blood and cerebrospinal fluid, which demonstrated a marked increase in the number of rabies virus antibodies compared with samples obtained on the first day of hospitalization. Her body was on the attack, striking back at the viral invasion. Giese’s immune system had mounted a robust defense against the rabies virus and delivered it to the embattled central nervous system. With this welcome piece of news, her doctors began gradually to withdraw the anesthetics. The girl’s return to consciousness was observed anxiously by Willoughby, who could not be sure what to expect. The medical literature had described survivorship among unvaccinated animals, he wryly notes— but in animal studies, “every time you get a survivor, you euthanize it.”

Although the electroencephalographic findings improved after the withdrawal of ketamine, the only immediate change on Giese’s physical exam was that her pupils became responsive to light. No other reflexes were apparent. Her limbs lay flaccid on the bed. Willoughby worried silently to himself. “Oh God, I created a lock-in,” he thought— meaning someone who is conscious but unable to communicate or respond in any physical way. “It’s, like, the worst thing you can do.” The idea that Giese might survive rabies only to be left severely disabled was a constant source of worry during the days and weeks that followed....

""A Wisconsin woman who was the first person known to survive rabies without a vaccine has given birth to twins.""

"Unknown said...I thought it was Matt Winkler in 1970?"

"Unlike Jeanna, he had received the rabies vaccine, though not until four days after the bite. He, too, developed clinical rabies. But after a six-month battle with the virus, he stunned the medical world by surviving and recovering."

Last summer I woke to find a bat in my bedroom at my lake home up north. CDC protocol is to assume the bat has bitten you. Fortunately, I was able to catch it, and testing proved negative. But I was going to get the shots otherwise, although people laughed. Read this story, and see if you laugh.

The doctor Rodney Willoughby was a prep school friend of my younger brother. He spent one Thanksgiving with my family on the east coast. Very bright dedicated young man. He went on to Princeton and then to medical school at Johns Hopkins. Yes, time flies.

The treatment Jeanna Giese received is called the Milwaukee Protocol — basically an induced coma with antivirals — and has since been used about fifty cases. It gives some hope for recovery, but the odds are still long, one in five at best.

A surprising number of people contact rabies, mostly children, without having been bitten. Not every sick animal is aggressive, depending on the stage of the infection a contagious animal can be lethargic and apparently oblivious to being approached or handled, which encourages sympathetic people to try to comfort the animal. This is what happened to girl who lived nearby me back in 1981. She discovered her horse in a state of lethargy in a turn-out paddock. The animal stood stock still, its head hanging low, in a condition that made the girl fear her horse had a colon torsion, she examined the horse and noticed a copious flow of salvia, some of which got on her hands and arms. A vet diagnosed rabies in the horse and made sure that everyone who had had contact with it received the post exposure prophylaxis. The girl developed symptoms, but survived.

Apparently there are people with natural immunity have survived rabies without treatment.

Jeana is one lucky lady. She and her family handled the bat-bite situation all wrong and didn't take her to a doctor until she developed clinical signs. I'm glad she recovered and has gone on to lead a normal life.

Assume that every bat who is acting oddly is rabid. And get to a doctor if you know or think you might have been bitten.

Rabies is a neurotropic virus, which means that the virus targets nerve and brain cells. When a nerve cell becomes infected its normal functions are interrupted. The effect is remarkably similar to some forms of nerve gas, such as Sarin and Taibun. The infection spreads very slowly however, unlike Sarin, which can kill in minutes. (Rabies is like HIV in this respect, being very slow to advance, since both are RNA retroviruses.) Advanced rabies causes a condition known as hydrophobia. In the past it was believed that victims would refuse to drink even though desperately thirsty. The actual effect is swelling of the esophagus preventing swallowing rather than "fear" of water. A rabid animal such as a fox will typically die of dehydration before the infection can have a fatal effect on its brain. Humans, however have been know to live as long as forty days, the victim being restrained and being fed and hydrated through a tube. Eventually the virus will destroy enough of the central nervous system that the victim dies of cardiac arrest.

Why are so many rabies cases associated with bats? There are many ideas and hypotheses. One states that bats are much more abundant than we tend to believe, so that even if a tiny fraction of their populations are infected that still represents a very large absolute number. Another hypothesis points out that bats live in communities, sometimes thousands of individuals, that cluster tightly together in their roosts, consequently if one contacts the virus it won't be long before the whole colony becomes infected.

One curious thing about bats is the fact that they're vulnerable to the disease in the first place. Some mammals, most notably small rodents and lagomorphs are immune to rabies. It's thought that the high body temperatures of small mammals prevent infection by the virus, an idea reinforced by the fact that large-bodied rodents like beavers and cavies are susceptible to rabies. Bats of the suborder Microchiroptera have some of the highest body temperatures of any mammals, which should protect them, but they are nevertheless among the most important vectors of rabies. However, while they are among the hottest mammals they are also among the coolest. In wintertime bats are able to cool down as much as 40 degrees allowing them to survive without food even though they have virtually no fat reserves, in short they hibernate. Most mammals are incapable of true hibernation. Bears cool down five or six degrees which allows them to live on their fat for many weeks, but they never actually hibernate. The speculation is the rabies virus uses the bat's over-wintering metabolic strategy against them. If true then the most dangerous time for bat to human transmission is early to mid spring when newly contagious bats are starting to awaken from their torpor.

Quaestor said, 'Advanced rabies causes a condition known as hydrophobia. In the past it was believed that victims would refuse to drink even though desperately thirsty. The actual effect is swelling of the esophagus preventing swallowing rather than "fear" of water.'

You write well. Where are your books?

"Phobia" has rapidly morphed from "fear" to "hatred". Islamophobia, homophobia, etc. English-speakers would be better off if they just used a few more words. "Rabies induces swelling of the esophagus, which prevents swallowing" is instructive, where "hydrophobia" is both non-instructive and etymologically crappy.